What is Rotationplasty: Overview, Benefits, and Expected Results
Rotationplasty is a surgery that involves the rotation of a limb and reattachment to the body. Generally, this procedure is performed when a patient has a tumor in a lower limb or has a traumatic amputation due to a severe injury. The goal of the surgery is to provide a functional limb, usually an ankle joint or knee joint, while maintaining the patient’s vital function. In this article, we discuss the overview, benefits, and expected results of Rotationplasty surgery.
Rotationplasty is a complex procedure that requires expertise. During this procedure, a surgeon removes a tumor or damaged limb from the original location, then rotates that limb and reattaches it to the body. Typically, the limb is rotated 180 degrees before being reattached. After reattachment, the foot is turned to face backward while the knee is turned to face the front of the leg. This creates a functional “ankle joint” out of the original knee joint and a functional “knee joint” out of the original ankle joint. The patient may also have an artificial foot and/or ankle joint made out of plastics, metal, or other peoplastic materials that is attached to the lower part of the leg.
Rotationplasty offers many potential benefits to patients. Firstly, it allows the patient to retain the original limb, which is important for psychological and emotional reasons. The procedure also reduces the potential for any future physical disabilities, such as joint stiffness or movement impairment. Additionally, it often requires shorter hospitalization and recovery times compared to more traditional amputation procedures. Finally, it can allow the patient to return to their pre-operative level of mobility more quickly.
The expected results of Rotationplasty depend on a number of factors, including the pre-surgical condition of the patient, the type of tumor or injury, and the expertise of the surgeon performing the procedure. Generally speaking, the goal of the surgery is to provide the patient with improved mobility and function. It is possible for patients to return to pre-operative levels of activity, including walking, running, and playing sports. Additionally, some patients are able to wear prosthetic devices after the surgery to help them with everyday activities.
Like any surgery, Rotationplasty has potential risks. Common risks associated with this procedure include infection, blood clots, nerve damage, and loss of sensation. It is important for patients to talk to their doctor about any potential risks before making a decision to undergo Rotationplasty.
Recovery from Rotationplasty depends on a number of factors, including the patient’s pre-surgical condition, their age, and the complexity of the procedure. Generally speaking, patients can expect to be in the hospital for four to seven days after their procedure. Physical therapy is often prescribed to help the patient regain strength and flexibility. It is important to follow your doctor’s instructions carefully during the recovery period to ensure the best possible outcome.
Rotationplasty is a complex surgical procedure that can provide patients with improved function and mobility. The procedure involves the rotation of a limb and reattachment to the body, and has potential benefits such as improved psychological and emotional well-being, as well as reduced potential for any future physical disabilities. Before making a decision about Rotationplasty, it is important for patients to speak with their doctor about all possible risks and benefits to ensure the best possible outcome.
Definition and Overview
Rotationplasty is a rare surgical procedure that involves removing tumors in the leg and rotating the feet and ankle 180 degrees to serve as the new knee joint. Also called Van-Nes rotation (named after the doctor who pioneered the procedure), it is often performed to improve mobility following an amputation.
The procedure, which is known for its high success rate, is a type of autograft procedure since the limb used belongs to the same person. However, while autograft is not new, Van-Nes is not commonly performed, and there are criteria that have to be strictly met before it can be explored.
Who Should Undergo and Expected Results
Rotationplasty is usually done on patients who are diagnosed with bone cancer (osteosarcoma), particularly on the distal femur (or the end of the thighbone that is closest to the knee joint). Although it can be performed on patients of all ages, it is mostly done on children and teens as they are more prone to developing osteosarcoma. And because the patients’ bones have more time to grow and mature, the success rate of the procedure is very high. However, it is important to note that rotationplasty does not cure bone cancer but is an effective method of preventing the disease from spreading to other parts of the body.
How Does the Procedure Work?
Rotationplasty or Van-Nes rotation is a long and complex procedure that can take as much as 10 hours to complete. It requires general anaesthesia and intensive care unit admission for at least 24 to 48 hours.
During the procedure, the tumor is dissected along with a part of the tibia (shin bone) and the femur. Extra tissues will also be taken to determine if cancer has already spread to other parts of the body. The rest of the leg is then attached to the remaining femur bone with the ankle and feet rotated 180 degrees. This way, the ankle can work in the opposite direction and function like the knee joint. Metal screws and plates are placed to help the bone heal.
Possible Complications and Risks
One of the short-term complications of the procedure is an infection, which may result from the lack of blood supply circulating in the remaining limbs.
In the long term, Van-Nes rotation may introduce unequal bone length, which means the child may have to undergo more surgeries. Thus, surgeons need to plan ahead for future bone growth, which may include removing the growth plates of the knees and creating a residual limb when and as needed.
Further, even if the procedure successfully helps patients transition to using a functional prosthesis, patients will still require intensive physical therapy, several prostheses changes, and counseling to help deal with the physical changes brought about by their condition.
Sawamura C., Matsumoto S., Shimoji T., et al. Indications for and surgical complications of rotationplasty. Journal of Orthopaedic Science. 2012;17:775–781. doi: 10.1007/s00776-012-0278-9
Gottsauner-Wolf F., Kotz R., Knahr K., Kristen H., Ritschl P., Salzer M. Rotationplasty for limb salvage in the treatment of malignant tumors at the knee. The Journal of Bone & Joint Surgery Series A.1991;73(9):1365–1375